Data isn’t enough for this decision

The numbers can only tell us so much about what kind of society we are and what is acceptable risk for the vulnerable among us, writes Courtney Addison of Victoria University of Wellington

This week there was a proposal by several academics to end the national Level 4 ‘lockdown’, skip Level 3 and move straight toward something more like Level 2. This suggestion, which they call ‘Plan B’, has been critiqued for its data as well as the poorly chosen international comparisons on which it is based. However, there is a more fundamental problem with Plan B: the line these researchers draw from data to decision is not a straight one.

Of course, it never is; the process of interpreting data and trying to grapple with its real-world consequences can never be objective. However, in this case the stakes are high (literally life and death) and it is therefore essential to spell out very clearly where evidence becomes judgement.

When the Plan B group say we should move toward something more like Level 2, they are saying the risks of the lockdown outweigh the benefits.

Risk-benefit analyses like this are central to much decision-making, especially scientific decision-making. We weigh up the risks and benefits of adopting new medicines, of implementing legislation to protect our waterways, of investing in sea walls, and so on.

Inherent in risk-benefit analyses are probabilities: we attempt to extrapolate data collected in one set of circumstances into a different set of future circumstances. One example is considering how well data from a clinical trial can inform future outcomes in a patient population. Another is considering how well one country’s public health strategies might apply to another’s.

Often the risks and benefits are cast in economic or health and safety terms. For example, does a new drug have a safe enough track record in clinical trials to adopt for our population? Will it result in long-term health savings? Is the price of that drug low enough that those benefits are ‘worth it’?

This is where we hit the upper limit of what our data can tell us. It can tell us what the risks (side effects, cost) and benefits (improved survival, symptom management, etc) are. (Although, because this is always a process of extrapolation, these judgments aren’t perfect and must be undertaken with care and criticism.)

When it comes to making a decision, though, it’s not just about what the risks and benefits are – it’s a decision about whether the balance between them is acceptable or not.

The answer, of course, depends on who you ask.

If you ask a healthy young person who is bored at home and currently out of work if it is worth ending the lockdown sooner, and if that person is acting primarily in their self-interest, they might agree with the Plan B proponents. For that individual, the cost (lost earnings, boredom, isolation) probably outweigh the benefits.

Put the same question to a cancer patient immunocompromised from their chemotherapy, or an older person who has had a couple of episodes of pneumonia in recent years, and they might give you a different answer.

Which of them is right? They are all experiencing discomfort, uncertainty, possibly fear, and none of those feelings are negligible or measurable.

However, the premise of this thought experiment is deliberately flawed: it frames us all as individual, self-interested people, instead of as the social creatures and community members we are. That healthy, bored young person may be close to their immunocompromised neighbour and it might be their grandparent who is anxiously reading the news and worrying about their lungs.

Not only is our vulnerable population much larger than many people seem to realise, it is larger still when seen through the many social circles within which each vulnerable person exists. A community is more than the sum of its parts and the loss of one person is typically felt by many more.

In addition to this actual, lived experience, our ways of creating and participating in community are also symbolic: are we a community that will be defined by collective care in times of crisis or by our willingness to rationalise loss?

It also bears noting that our vulnerable community isn’t a neutral sample of the New Zealand population. A decision that puts ‘vulnerable’ people at risk is actually a decision that puts Māori, elderly and the disabled and sick at disproportionately higher risk.

The agency involved in this equation is important: to move too far from Level 4 prematurely is not to accept these groups are at higher risk of death or injury from Covid-19, it is to actively put them at risk, based on the reasoning that the risk to them is outweighed by the benefit to the rest of the population.

The language of risk and benefit tends to give a false neatness to what is messy. There are risks to remaining in Levels 4 and 3 as well as to ending them. Levels 4 and 3 mean people are at home with domestic abusers, while others are consigned to live in cold, mouldy or otherwise sub-standard housing. We know that at Level 4 people are losing money and jobs and haven’t been able to see their loved ones before they die. These are all enormous sacrifices. Nobody is pretending the price isn’t high.

But when we make decisions, we make them for each other as well as ourselves. The decision about when and how to exit Level 4 and then Level 3 is deeply informed by how we regard each other and our society more broadly.

This decision doesn’t just reflect the society we live in and our collective values. It also creates that society into the future.

When we sit in our homes with our families or flatmates and talk about leaving Levels 4 and 3, let’s talk about what kind of communities we feel part of, and what kinds we’d like to create as we go forward.

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